By Elizabeth DiBona, Guest WriterSo, your dentist is no longer contracted with your dental insurance (ie, going “out-of-network”). Here's why that might be a great thing for your teeth.
“Out of network,” “unrestricted provider,” “not contracted with dental insurance corporations,” and “fee-for-service:” Essentially, these all have similar meanings, and your dentist might have a specific way to describe what being out of network is. Dental insurance may describe it in a confusing way, like, “You need to find a new dentist.” But you do not. In fact, you probably should not, because, as I will summarize below, using a dentist who works independently from dental insurance might be great for your dental health.
To summarize the main types of dental practices out there right now:
- Privately owned and completely independent from dental insurance (aka fee-for-service, out of network, or unrestricted provider). This is my practice now, although previously, for four decades, we were in-network with one insurance company.
- Privately owned dental practices that still contract with insurance companies. These offices are often given extremely low, below-standard, and customary procedure reimbursement fees from the insurance companies they contract with (hence the shift I am writing about).
- Private equity-owned dental practices.
A lot of shakeups have occurred since the pandemic, and one thing you might be noticing is a shift with privately owned dental practices. Many dentists are throwing off the shackles of dental insurance and practicing independently. Decision-making and quality control are shifting back into the hands of dentists. Why now? Staffing shortages, increased overhead, and the inability to control our reimbursement fees have led to this shift.
Another result of the pandemic is that low interest rates made scooping up dental practices more enticing for private equity groups; thus your dental practice might be purchased by a large corporation. This is almost the other end of the spectrum from an office that ended its contract with insurance corporations. Which one is better?
Why I Am Strictly a Fee-for-Service Dentist
Full disclosure: I have a private practice that is not contracted with any dental insurance companies (we are fee-for-service). I took over the practice from my father, and I was fortunate enough to be in the position of having a loyal following of patients who understood why we could no longer provide quality dental care while contracting with dental insurance plans. However, I have plenty of colleagues who are looking to retire, and private equity groups are paying above-appraised value to purchase the practice—thus, many of my fellow dentists have gone the other route. New dental school graduates have been dismayed how they could not compete on bids for purchasing existing private practices because the bank would not lend them above-appraisal value. That's one way private equity has an advantage over new dentists. Another path some dentists take is completely starting a practice from scratch. Although this is a less common path and it's certainly filled with its own set of challenges, there are some fantastic dentists out there using this model with incredible success.
Other private practicing dentists find themselves in limbo, trying to figure out what direction to take: drop insurance altogether, tough it out with the insurance companies and increase procedure volume to make up for the low reimbursement fees, or sell to PE? These dentists have high-quality practices but are still contracting with the big insurance giant. However, their ability to practice without interference from dental insurance is dwindling (for example, denied claims for administrative reasons, denied claims because some plans don’t cover basics like periodontal therapy for moderate to severe gum disease), and these dentists are very eager to drop insurance plans and practice independently. But they are concerned about losing patients.
Simply put, dental insurance is not catastrophic coverage, like medical insurance. Patients do not necessarily need it. Some might argue it actually causes more harm than good. Why? Because dentistry involves materials, technology, and highly skilled hands.
More information here:
Is Dentistry Worth It? Comparing It to Being a Pediatrician, a Planner, and a Plumber
Downsides of Low Insurance Reimbursement
If you start reimbursing much less than is needed for high-quality dental care, you start getting the following potential downsides of low reimbursements:
Dental Assistants Placing Fillings
Let me just make a note that placing a composite filling in your mouth is still one of the most technique-sensitive things I do today. I routinely place dental implants, perform sinus bone augmentations, do cosmetic work, and so on, but placing white composite fillings involves a lot of possibility for error—like getting air bubbles, voids, and inaccurate margins, even for those of us who are incredibly experienced. Post-op sensitivity may increase with someone who is not as highly trained at doing fillings. However, dentists are training their assistants to do the “placement” part of the filling for better efficiency, so they can move on to the next patient. This is not giving the patient the best quality care.
Dental Hygienists Given Shorter Appointment Times
Remember the dental hygiene shortage after the pandemic? Well, guess what? They want more money to return to work. And they DESERVE it because removing plaque from your teeth is backbreaking work, and if you don’t give them enough time or money, there is likely going to be plaque left behind. Plus, the less time you spend with your hygienist, the less time they can educate you, diagnose something before the dentist comes in (or alerts the dentist to something if you are not due for an exam), or review a customized home care plan with you. Again, the patient will suffer.
Cheaper Dental Materials Will Be Used
Do you know that it’s clinically acceptable for dentists to order dental crowns from anywhere in the world? Do you know that labs are hiring inexperienced dental technicians to meet the demand for “cheaper” dental crowns? The filling materials we order can range tremendously in price as well, with the higher-end ones costing about 5X that of the lower-end ones. Let me put it this way: everything I put in my own mouth (I’ve had fillings, crowns, etc.) is the EXACT material made by the same exact lab technicians that make your crown in my office. I’ve even heard of some dentists using different materials/labs for different insurance plans (although this doesn’t sound ethical or legal to me . . . but I think the dentists are just trying to make it work for the patients). In other words, if your dental plan reimburses peanuts, you just might be getting peanuts for materials in your mouth!
Dentists Seeing Higher Volume of Patients
Dentists are “proceduralists.” We are looking through loupes all day long and holding extremely sharp objects over your face. Meanwhile, patients are terrified of us. This can wear down our capacity to treat everyone at 100% of our ability. After switching to our new service model, my schedule slowed down, and I realized that if my brain isn’t completely fried, I can think more critically about my treatment plans. I have time to collaborate with my peers on complex cases. I can be a better dentist.
Now, it might just sound like “out of network” dentists are catering to the rich, but that is not the case. I have an office filled with people who want the best quality in their mouth, and (similar to building a house with high-quality materials) they want it to last a long time. My patients are house cleaners, police officers, teachers, veterans, retirees. Of course, we have many well-off individuals as well. Most of the patients who left my practice after we went “out of network” were those who still take their Disney vacations, still have their ski homes, and still drive their luxury automobiles. But they preferred to save money by going to the “in-network” dental practice.
More information here:
A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way
How Much Does It Cost to Become a Dentist?
Benefits of Fee-for-Service or Out-of-Network Dental Practices
What benefits might you see popping up at fee-for-service or out-of-network dental practices, like my practice?
In-House Membership Plans
Dental membership plans are about $50-$60 per month in most practices. This is a membership through your individual dentist, not an outside company. It appeals to patients because they can take more control over their health while knowing their dentist can see them for same-day emergencies. These dentists use long-lasting crown materials, and we have time to attend continuing education training and to keep up with the latest technologies. Plus, out-of-pocket expenses are often similar to those going online and purchasing name-brand dental plans. But with in-house dental membership plans, you don’t have a deductible, you don’t have rejected claims, and you don't have maximum benefits. Instead, you have a dental team that is attentive and caring.
Treatment Plans Based on Your Actual Needs
These are the dentists who are making treatment plans based on your oral health needs and not just “what insurance covers.” Patients do not benefit when insurance has a seat at the table in deciding what care benefits them. For example, I have no problem telling a patient the tooth needs a crown and not just a filling. But if insurance covers “just a filling,” some dentists might not feel as confident telling patients what their mouth would benefit from, because they are concerned patients will get upset with out-of-pocket expenses. I tell my patients, “This is what I would put in my sister’s mouth.”
Somehow, patients have become used to insurance dictating what is needed to keep them healthy. But dental insurance functions more like a middleman, causing costs to increase without really benefiting you in the long run.
Well-Trained Teams to File Your Insurance Claims for You
You might also see practices catering more to you. We have a dedicated insurance claim employee who, as a courtesy, takes your claim form and files it for you.
Dentists Who Can Take on More Charity Work
Having more free time during my clinic day allows me to take on cases from our New Hampshire dental society for free care, which has been incredibly rewarding.
Private Equity-Owned Dental Practices
What might you see in private equity-owned dental practices?
First off, you won’t know it’s owned by private equity, because they look exactly the same as before they were purchased. They don’t call themselves “Private Equity Dental,” but if you ask their staff, “Who owns the practice?” you can figure it out that way. One of the biggest private equity groups in the country started its own dental school. I can’t yet comprehend the full implications, but it means that private equity is starting to train a lot of dentists.
You will also see lower fees at PE-owned dental practices. Most of these offices take a lot of insurance plans, and because they own hundreds of offices, they have more negotiating power for insurance reimbursement rates and materials/lab work.
In general, these practices might hire students right out of school, burdened with dental school debt, but the private equity companies offer a lot of CE training as a trade-off. Typically dentists who work in these corporate settings give up some autonomy, but the tradeoff is that someone else runs the practice for them, does the staffing, and deals with the headaches of the business side of things.
The downside of not having the autonomy to choose your dental labs, choose your dental materials, or choose the amount of time you have per procedure is that quality can suffer. Dentists are picky people. For example, I use three different dental labs, one for All-on-X implants, one for crowns, and one for dentures. If I were limited to just one lab, I couldn’t search for the best technician possible for the case. Filling material is another area I’m extremely picky about; there are a million and one options out there for composite filling restorations. I choose the ones that have the most durability and cause the least amount of post-op sensitivity.
Potential Impact on Patient Care
My overall feeling toward PE-owned practices is that they will focus on volume and speed over quality. Many PE practices have quotas for the day, and some give out bonuses based on the volume of dentistry performed each month. High volume does not typically go hand in hand with high quality, and I believe quality of care suffers. I know some amazing dentists who work for private equity, so there probably are some great dentists out there who will be upset at my generalization. But I truly believe quality improves with a smaller, more controlled setting. Furthermore, private practices like mine have a dentist (me) who will be here in another 10, 15, or 20 years, so I want your dentistry to last as long as possible. I specify that labs use the best Certified Dental Technician to do the case. In PE practices, many of the dentists move from location to location. Or they do it until their debt is paid off, and then they try to go into private practice. So, if you have a problem with a dental crown that was placed a few years back, you might be out of luck.
Since this is a financially focused group, I would be remiss if I failed to mention that, in the long run, you will likely also win out in the end with money spent on dental work. Again, think better materials, better labs, and better-trained dentists and hygienists as the result of an office going “out of network.” Your dentistry will likely last longer, your dentist/hygienist/assistant will love what they are doing more, and they will likely give you dental work that will last longer than dentistry done in a high-volume setting.
The old adage of you pay for what you get couldn’t be more true with your teeth. My father placed crowns in the '70s and '80s that are STILL in patients' mouths today, and that’s because he had extremely skilled hands and he used highly trained dental technicians who used the best materials possible.
More information here:
Selling Your Practice to a Private Equity Firm
Food for Thought If Your Dentist Is Going “Out of Network”
Think of your mouth like a house that you have to live in for the next 50 years. A builder can use cheap materials and cheap labor, and your bill will be small. But if you do that with the materials that go into your mouth and you use a dentist who is rushing and might not have as much training as those of us who practice independently, you can’t just “buy another mouth,” like you can with a house.
Protect your mouth and teeth as best you can. And if your dentist tells you they are going “out of network,” be excited. It might mean you are getting amazing dental work.
What do you think? If you're a dentist, have you thought about going out of network or actually done it? What happened as a result?
Excellent overview of our current dental world and the stratification occurring . Dentistry is the last independent medical profession but is currently under assault by the same forces that got medical a long time ago. We started a practice from scratch 30 years ago and our daughter purchased an “in-network” office during the height of COVID and has transformed it to completely out of network and it is thriving! Please continue to help our profession and patients by sharing your message – especially with the graduating dental students.
Out of network means more and more people can’t afford dental services. This adversely affects everyone from school children to seniors. A new approach is needed and a new business model. I can afford out of network, but most of my friends can’t and hence are missing teeth, missing care all together.
This is the big lie perpetuated by medical schools and dental insurance companies and their surrogates. People absolutely can afford out-of-pocket dental care just like people can pay out-of-pocket for groceries, vehicles, dry cleaning, pet food, vet services, gasoline, and utilities. People pay for the things they want. If I had a dime for every time a patient told me they couldn’t afford a dental service as they set their LV purse on the countertop next to the keys for their $55,000 Chevrolet Trailblazer, I wouldn’t have to work anymore. Stop spreading this lie throughout the medical community, and stop lying to yourself about what patients are capable of.
I think both of you are right. Lots of people can pay cash, especially if they prioritize it. Others who can afford to pay cash choose not to, they’d rather have bad teeth and a nice cell phone plan. And there are some people that truly don’t have the money to pay for dental care because that money is going to groceries and rent.
Yes! Thank you. I’m in private practice and so over insurance companies. People have this mind set that they can’t afford self pay. It’s ridiculous. Take out the middle man, my costs to run a practice go way down and I can actually charge a self pay fee that most can afford. We are getting closer and closer to concierge and I run an ophthalmology practice.
Isn’t the underlying assumption that patients can absorb the out-of-pocket additional costs? It may be that those have the means to afford the price differential do receive better treatment. Those that can’t might not seek treatment, delay treatment, or pursue a lower cost alternative. Does this create an access to care concern?
Yes.
It’s an age-old dilemma. Do you maximize access to care by working for free or do you maximize income by limiting access? It’s a spectrum and every doc will find themselves somewhere on it. You’ve got to make payroll but you also need to be able to look yourself in the mirror and be proud of how you’ve lived your life.
How do we find private practice dentists? We have had some suspicions re our own dentist using the dental assistant for everything
What do you mean suspicion? You can’t see who’s working in your mouth?
My interpretation of Erin’s comment is that she has observed her dentist doing less of the things they used to do and noticing that those intraoral tasks are increasingly done by clinical support staff.
There has been increasing encouragement from practice consultants, dental CE courses, and in online forums for dentists to “work at the top of their license” as often as possible in order to increase efficiency and productivity. This has happened in conjunction with clinical support staff (i.e. hygienists and dental assistants) being given increased opportunity to do more intraoral tasks by state dental boards.
For example, in many states EFDAs (expanded function dental assistants) can place sealants, make and place temporary crowns, place temporary or permanent filling material (after the dentist has “prepared” the cavity aka “drilled the tooth”), reline dentures, apply fluoride, complete “simple” cleanings, remove excess cement after permanent crown placement, etc.
This did not always used to be the case and is new, surprising, and/or upsetting to some patients.
At its best, the expanded functionality of support staff allows the dentist to care for more patients by handing off less specialized work to others who can preform those tasks as the same standard of care the dentist otherwise would.
At its worst, it is a slow moving coup against the high standard patients expect and deserve as dentists are increasing motivated/pressured/forced to increase volume by capitalistic drivers that are less than ideal.
I was very grateful for my very competent EFDAs who I could rely on to do exceptional work (shout out to Ruth) and very anxious when Ruth was out for the day and I was expected to hand off those same tasks off to someone with the same credential but with far less competence.
I imagine there are some parallels for my physician friends who work with an ever changing group of MAs, nurses, and various other “mid-level” providers in their day to day work.
I don’t think many expect doctors to work for free. But is having a 50% profit margin in health care reasonable (one person’s reasonable is another’s excessive)? As you said, you gotta live with your choices.
You should spend some time in an emergency department if you think nobody expects doctors to work for free. 20% of my patients don’t pay me and most of those don’t even say thank you for working for free.
Markets have a way of eventually working out reasonable profit margins. The problem is when markets don’t work and they don’t work very well at all in health care for various reasons.
Most dental practices do not have a 50% profit margin. I think it’s reasonable to expect 35-40%. That’s still higher than most of medicine. I’m perfectly fine with those margins. I took out 1.85 million in loans to go to school and buy a practice. I’ve invested additional 300k in improvements. Why would someone do that without making a profit?
I’m mostly in network with PPOs. No Medicare or Medicaid. We started dropping insurance. If 50% of people stay, the profit is the same. My work is good and I don’t cut corners. That being said, a delta patient isn’t going to a high end lab. It’s not feasible. I refer out anything that isn’t profitable. It’s a business.
This article could be summed up as follows:
More dentists are going out of network because the insurers and PE firms have developed negotiating leverage and the dentists are betting they can earn more by going out on their own.
Dental insurance typically isn’t very valuable but this article makes a lot of inaccurate conclusions. I have 3 kids and a wife whom have different dentists but each with one of those yearly plans. What has happened is that after they get on the hook, they get shorter cleanings, are more likely to be rescheduled then a new patient, and there is zero evidence of higher quality material. They don’t seem to get any emergency preference or discounts on other items. Dentists frequently make more money doing x,y or z and gravitate to it. That’s what is happening. This article is just rationalizing it. Dental insurance isn’t great so this isn’t a big deal.
It’s important to note that “corporate” and “private equity” practices also have in-house dental plans. Your family might be at one of those offices.
The first half of the article describes ways that dentists can make more money when they are getting paid by insurance companies (more patients, less time, cheaper materials, etc). It’s quite a big assumption to claim that dentists won’t do the same thing just because the patient is paying the bill directly.
Via email:
This is a highly biased article and completely inaccurate. I work a PE and I have complete autonomy. I treat my patients exactly the way the “fee for service” dentist treats her patients. I would be more careful about allowing someone so biased to bash something they know nothing about.
It is absolutely true that some dentists who work for DSOs (Dental Support Organizations aka Private Equity) have complete autonomy. It is absolutely true that many do not.
The extremely wide range of policies, practices, incentives, and business models in the expanding DSO universe is part of what makes these conversations so challenging amongst our dental peer group, let alone how complicated the implications are for patients who don’t have the same insights we do.
The notion that a DSO owned practice provides sub optimal care is definitely unfair if not outright lazy.
The notion that a DSO owned practice provides the same standard of care as private fee-for-service office is definitely optimistic if not outright naive.
Thank you so much for this article as it embodies all of the things that are wrong with dental insurance nowadays. Greedy private equity firms, and corporate Billionaires are trying to push the doctors out of the profession by telling us how to treat our patients. the only two people involved in the doctor. Patient relationship are the doctor and the patient.
Nobody else should have a say, as to how much something should cost and how good it should be or how long it should last. that conversation is for the doctor and the patient to have and there should be no more middleman in healthcare. People are brainwashed nowadays to think that insurance companies somehow magically work for them. The truth cannot be any further from this.
I encourage every dentist to take a long, hard look at their relationship with insurance companies, and if it is not working for you, please do everyone a favor and drop out of participation with insurance companies, because insurance companies have acted with impunity for the last several decades, and they have no right to run this business.
Speaking STRICTLY as a consumer of dental services, I really like “fee for service” dentists. From my experience, they tend to do some of the best quality dental work the FIRST TIME and are available in the case of an emergency. My current dentist does not deal with insurance companies but will provide you the documentation to file a claim should you have it. ALSO, if you have an emergency off-hours, they will take care of you.
We have looked at dental insurance since retirement. However, the limitations of the dental coverage really provides you with so little benefit if you need major restoration work. We found that in MOST years, having insurance that we paid for would NOT break even and in years where we had multiple claims we would get maybe $200 benefit from it.
What I like about dental practices is that they can give you a quote for services upfront ao that when you leave the office, you can pay and never be bothered with dozens of billing requests.
One thing that was NOT mentioned that affects us here in Arizona is the number of people who run across the border to Mexico for dental services. Many tout that the offices are modern and the dentists are better. However, I have had to drive a couple of friends to the emergency rooms after botched procedures at dental clinics in Mexico …
Thanks to the author for this great article and saying it like it is. While maybe not popular to be “honest” about the current state of dentistry, she is spot on. The nice thing about the free market in dentistry, if you want “cheap” dentistry in your mouth, you can do that…. There are many choices out there, if you want the highest quality dentistry available, well then you get what you pay for, like many things in life. And PE is bad news for dentistry as a whole, which means it’s bad for patients as well.
Very biased
I’m a rural pediatric dentist that takes most insurances, including Medicaid. Working on awake kids you have to be fast, try having a 4 year old sit in the chair for 2 hours. How long the dentist spends working does not directly correlate to quality of care. If I didn’t take Medicaid my community would suffer.
There different models for dental practices, bashing non fee for service dental is a low blow and ridiculous.
The primary reason for both dentists and physicians going out of network is the fact that both private insurers and government have refused to raise reimbursements to keep pace with inflation. This hits dentistry particularly hard because it is a high-overhead business. This has become all the more painful with the inflation of the last few years. Private insurers continue to raise premiums, maintain profitability, and give their staff raises without passing anything on to providers. My experience with both medical and dental insurers is that they refuse to negotiate with independent practitioners. This leaves the doctor with the difficult choice to suck it up and continue as is, drop out of networks, or join a corporate/ hospital group with more control over overhead and negotiations. None of these are easy decisions and unfortunately, the patients get stuck in the middle. The only thing that will make insurers change is if they start losing subscribers due to a lack of value in their policies.
Exactly right except that many private insurance contracts are tied to Medicare rates and payments have actually declined as Medicare physician rates have been cut. Our physician group is looking at going out of network with BCBS which refuses to negotiate. With the No Surprises Act, the effect on patients should be minimal and at least we’re guaranteed annual adjustments for inflation.
Great article!
I appreciate you explaining the true differences in practice types. Overall care and quality contrasts are vast.
I had purchased a previous practice in the ‘90s. Since then we shed BCBS, then Delta. The relationships with long term patients was the best part of ownership. Finally had to hang it up in ‘21, but we sold it to an independent dentist as opposed to a corporation.
I really enjoyed your article. It was well thought-out and I could tell you put a lot of time into researching the facts. I am in the process of leaving PPO participation with insurance companies, and the main reasons are very similar to what you presented above.
We owe it to our patients to give them the very best. To do that, we have to use the very best and keep our minds and bodies at their very best. I do not believe that is possible in an environment of low insurance reimbursements hampering our ability to afford quality materials and forcing us to work faster/see more patients and inevitably decrease our quality of work
I think the author’s statement that fee for service dentists will “use higher quality longer lasting materials” is very problematic. Dental consumers have no way of knowing what materials are superior. Their out of network dentists can charge what they want, use cheap materials and pocket the difference.
My family’s dentist of many years just stopped accepting our insurance and we left the practice. Our former dentist sent us a very honest email that said reimbursement rates were too low and they wanted more money. It was very easy to find another in network practice nearby with great reviews on our local community forum.
While I understand this is a business decision, it’s certainly not one that many healthcare providers get to make. A large chunk of my patients have no insurance or Medicaid. I take care of anyone that comes in with no regard for reimbursement rates.
I think the dentists dropping dental insurance are making a selfish decision that will undoubtedly reduce access to care. They should own that instead of trying to convince people it’s some blessing in disguise.
I wonder how many of those here saying this is selfish actually own their business and know what it takes.
I think there are more partners/owners of private practices on this site than you might think.
I was a part owner of a small anesthesia practice and I know exactly what it takes. We lost a ton of units to patients who couldn’t afford care. We made up the difference by working long hours including nights, weekends and holidays. I doubt many dentists see patients at those times.
Well, the WCI poll shows most here are employees and have never owned a practice. But it won’t stop them from chiming in because physicians tend to think because they are smart, they are right.
Your proud story of working longer hours is the perfect example of how the stereotype is true… doctors are horrible with money/business. I did the same thing as you early in my career and worked harder to make up for losses. I did the “nights, holidays and weekends” mistake same as you. Then I heard the old saying “work smarter, not harder” so I did with appropriate business and insurance decisions.
You and the original poster are not “working smarter” than anyone, you are just denying care to people with limited means.
Don’t mistake greed for altruism.
Unlike dentists, many physicians would never consider limiting services to cash patients due to the catastrophic impact this would have on poor people in their communities.
If you want to act like Scrooge Mcduck and swim in a vault of money while blue collar families in your community get dental abscesses and lose their teeth, your call.
I think the original author is trying to put political spin on a very greedy practice model. I hope the government regulates you all and forces you to take insurance just like they do with many physicians.
Let he who is without sin cast the first stone.
I’m not going to pretend my group/practice doesn’t do things to try to make more money. Doctors aren’t running a charity either. No margin, no mission.
There’s a whole lot of space between Scrooge McDuck and working for free though and everyone has to figure out where the right place is for them where they can reach their financial goals and still look themselves in the mirror each morning.
Very biased article. It seems from the comments the only people who agree are other dentists in a similar practice.
How can you generalize that all PE dentists cut corners and all direct pay dentists provide better care? Do all private practice ER physicians provide better care than PE or hospital employed ER physicians?
To say that direct pay dentists use higher quality materials is a complete generalization with no evidence backing that up.
This article should say it like it is. This dentist inherited a practice from their father with a loyal patient base. They wanted to make more money so went direct pay. They talk about making more money in direct pay but if you did it purely for patient care then you could charge less, make the same amount you previously made, and then still provide better care. It’s a business and you want to make more money. Nothing wrong with that but be honest about it.
Finally, making the generalization that all the patients who left still went on Disney vacations, have ski homes, and luxury automobiles is as bad as the general public making the generalization that physicians/dentists make too much money.
I’ve been a practicing dentist since 1993. The reality is that the patients as well as dentists lose being in network. The only winners are the big insurance companies. That is why they push so hard for their subscribers to go “in network”.
An insurer I’m contracted with may pay me $160 for an exam, pro, Fl and pay my “twin brother at the same location practicing out of network” will receive $210 his full fee from that same insurance company doing the same procedures.
As far as fillings, insurers pay a tiny fraction by playing the “we only pay for posterior amalgams, and our reimbursement is ten cents “ when I do only composites. Guess who pays the difference regardless of network status?
I was forced to go into a couple of networks after an influx of “clinics that took every insurance “ opened near my office. When I left and went out of network, I had many pre- estimates as an in network dentist that I was able to compare to the same treatment I actually performed out of network. Trust me when I say that in almost every case I earned more and the patient paid less when I was out of network.
I wish my almost 2000 yearly ADA dues were used to fight against unethical treatment of dentists by these insurance companies. Until they are responsible for malpractice, nothing will change. 5 years for a panorex? What if a kid is 7 and then at 12 the eye teeth are impacted? Well mom refused the panorex because the insurance company decided to pay every 5 rather than every 3 reasonable years.
Don’t get me started. Great article. Thanks for writing it.
Edit. And one more thing- the new insurance play is “in network coverage only” that hurts everyone. Just wait. It’s coming.
So, as a patient, why do I need dental insurance when what I pay for monthly exceeds what it actually costs for a bi-annual cleaning and a filling or crown every once in a great while if I am diligent with by brush and floss. Why not just pay the fee and move on. Yes, some dentists are altruistic and others are Scrooge McDuck; it’s difficult to tell by looking into their eyes which one you’ve got rooting around in your mouth. So my dentist is going out of network, citing all the common core problems with insurance not keeping up with inflation already mentioned throughout this article. Which by all accounts is probably very true. What is the profit margin, how much is too much, and if I’m going to be out of Network, why should I even bother paying the corporate giant when I can just pay it to my local dentist. Too much BS, somewhere in the middle lies the truth and I’m probably never going to find it. But this article and all the opinions I’ve read have helped me make an informed, probably wrong, decision about dental insurance. Can I afford cleanings and filings and crowns…yes. Can I live without dental insurance…probably. Should I? Don’t know… But I have a lot of food for thought. Thanks.